Christoph Mueller1, Jonathan Huntley2, Brendon Stubbs2, Andrew Sommerlad3, André F Carvalho4, Gayan Perera5, Robert Stewart2, Nicola Veronese6. 1. King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom. Electronic address: christoph.mueller@kcl.ac.uk. 2. King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom. 3. Division of Psychiatry, University College London, London, United Kingdom; Camden and Islington NHS Foundation Trust, London, UK. 4. Federal University of Ceará, Faculty of Medicine, Department of Clinical Medicine, Translational Psychiatry Research Group, Fortaleza, CE, Brazil. 5. King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom. 6. National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy; Institute for Clinical Research and Education in Medicine, IREM, Padua, Italy.
Abstract
OBJECTIVE: Depression is associated with increased mortality in community samples. The use of antidepressant medication may also increase mortality, however, it is still unclear whether taking antidepressants before or after a diagnosis of dementia influences survival. DESIGN: Retrospective. SETTING: A cohort with a diagnosis of Alzheimer disease (AD) from a large mental health and dementia care database in South London, linked to hospitalization and mortality data. PARTICIPANTS: Mild dementia (Mini-Mental State Examination ≥18/30) at the point of diagnosis. MEASUREMENTS: We ascertained antidepressant prescription, either in the 6 months before or after dementia diagnosis, and used the HoNOS65+, a standard clinician-rated measure of patient well-being, to determine depression severity and other neuropsychiatric, physical health, and functional difficulties. We conducted a survival analysis, adjusted for potential confounders and addressed possible confounding by indication through adjusting for a propensity score. RESULTS: Of 5473 patients with AD, 22.8% were prescribed an antidepressant in a 1-year window around dementia diagnosis. Of these, 2415 (44.1%) died in the follow-up period [mean (standard deviation) 3.5 (2.4) years]. Prescription of an antidepressant, both before and after dementia diagnosis, was significantly associated with higher mortality after adjusting for a broad range of potential confounders including symptom severity, functional status, and physical illness (hazard ratio 1.22; 95% confidence interval 1.08-1.37 for prescription prior to dementia diagnosis; 95% confidence interval 1.04-1.45 for prescription post dementia diagnosis). In stratified analyses, risks remained significant in those without neuropsychiatric symptoms. CONCLUSIONS: The prescription of antidepressants around the time of dementia diagnosis may be a risk factor for mortality.
OBJECTIVE:Depression is associated with increased mortality in community samples. The use of antidepressant medication may also increase mortality, however, it is still unclear whether taking antidepressants before or after a diagnosis of dementia influences survival. DESIGN: Retrospective. SETTING: A cohort with a diagnosis of Alzheimer disease (AD) from a large mental health and dementia care database in South London, linked to hospitalization and mortality data. PARTICIPANTS: Mild dementia (Mini-Mental State Examination ≥18/30) at the point of diagnosis. MEASUREMENTS: We ascertained antidepressant prescription, either in the 6 months before or after dementia diagnosis, and used the HoNOS65+, a standard clinician-rated measure of patient well-being, to determine depression severity and other neuropsychiatric, physical health, and functional difficulties. We conducted a survival analysis, adjusted for potential confounders and addressed possible confounding by indication through adjusting for a propensity score. RESULTS: Of 5473 patients with AD, 22.8% were prescribed an antidepressant in a 1-year window around dementia diagnosis. Of these, 2415 (44.1%) died in the follow-up period [mean (standard deviation) 3.5 (2.4) years]. Prescription of an antidepressant, both before and after dementia diagnosis, was significantly associated with higher mortality after adjusting for a broad range of potential confounders including symptom severity, functional status, and physical illness (hazard ratio 1.22; 95% confidence interval 1.08-1.37 for prescription prior to dementia diagnosis; 95% confidence interval 1.04-1.45 for prescription post dementia diagnosis). In stratified analyses, risks remained significant in those without neuropsychiatric symptoms. CONCLUSIONS: The prescription of antidepressants around the time of dementia diagnosis may be a risk factor for mortality.
Authors: Brendon Stubbs; Gayan Perara; Ai Koyanagi; Nicola Veronese; Davy Vancampfort; Joseph Firth; Katie Sheehan; Marc De Hert; Robert Stewart; Christoph Mueller Journal: J Am Med Dir Assoc Date: 2020-04-19 Impact factor: 4.669